H5N1 avian influenza: Timeline of major events

Transcription

1 H5N1 avian influenza: Timeline of major events 2 June 2008 Early Events Date Events in Animals Events in Humans 1996 Highly pathogenic H5N1 virus is isolated from a farmed goose in Guangdong Province, China Outbreaks of highly pathogenic H5N1 are reported in poultry at farms and live animal markets in Hong Kong. Feb 2003 Human infections with avian influenza H5N1 are reported in Hong Kong. Altogether, 18 cases (6 fatal) are reported in the first known instance of human infection with this virus. Two human cases of avian influenza H5N1 infection (one fatal) are confirmed in a Hong Kong family with a recent travel history to Fujian Province, China. A third family member died of severe respiratory disease while in mainland China, but no samples were taken. Subsequent Events Date Events in Animals Events in Humans 25 Nov 2003 A fatal human case of avian influenza H5N1 infection occurs in China in a 24-year-old man from Beijing and is attributed to SARS. This case is retrospectively confirmed in August of 2006 (as the 20th human case in China). 12 Dec 2003 Republic of Korea first reports H5N1 in poultry. Outbreaks continue through September Dec Jan 2004 Two tigers and two leopards, fed on fresh chicken carcasses, die unexpectedly at a zoo in Thailand. Subsequent investigation identifies a H5N1 virus similar to that circulating in poultry. This is the first report of influenza causing disease and death in big cats. 8 Jan 2004 Viet Nam first reports H5N1 in poultry. Outbreaks continue to be reported on a regular basis. 1

2 11 Jan 2004 Viet Nam identifies H5N1 as the cause of human cases of severe respiratory disease with high fatality. Sporadic human cases are reported through mid-march. 12 Jan 2004 Japan first reports H5N1 in poultry, outbreaks continue in commercial poultry through March Jan 2004 Hong Kong reports H5N1 in a dead wild bird (first report in birds since poultry outbreak in 1997) 23 Jan 2004 Thailand first reports H5N1 in poultry. By the end of January, 32 provinces (throughout the north and several in the south) report outbreaks in many types of poultry, including fighting cocks, and outbreaks continue to be reported throughout the year. The virus appears closely related to the isolates from human cases in Viet Nam. Thailand prohibits vaccination of poultry. 24 Jan 2004 Cambodia first reports H5N1 in poultry. 27 Jan 2004 Lao PDR first reports H5N1 in poultry. Thailand reports two laboratoryconfirmed cases of human infection with H5N1. Sporadic human cases are reported through mid-march. 1 Feb 2004 Investigation of a family cluster of H5N1 cases, which occurred in Viet Nam in early January, cannot rule out the possibility of limited human-to-human transmission. 2 Feb 2004 Indonesia first reports H5N1 in poultry in 11 provinces. Outbreaks continue to be reported. Vaccination is allowed. 4 Feb 2004 China first reports H5N1 in poultry. During February-March, 16 mainland provinces are affected, and approx. 9 million poultry culled. Governmentsubsidized vaccination initiated. 20 Feb 2004 A report from Thailand confirms that a domestic cat was infected with H5N1 after eating an infected pigeon Mar 2004 Research 2 Jun/Jul 2004 China reports recurrence of H5N1 in poultry. Outbreaks continue to be reported in Indonesia, Viet Nam and Thailand. 8 Jul 2004 Research 3 Research identifies the dominant Z genotype in poultry, considers possible role of wild birds in spread, and Case studies of 10 patients in Viet Nam point to close contact with infected poultry as the probable source of infection in most cases, but conclude that, in two family clusters, limited human-to-human transmission within the family cannot be ruled out. 2

3 13 Jul 2004 Research 4 concludes that H5N1 has found a new ecological niche in poultry, but is not yet fully adapted to this host. Research shows that H5N1 has become progressively more lethal for mammals and can kill wild waterfowl, long considered a disease-free natural reservoir. Jul 2004 Research 5 A case report is published indicating atypical human H5N1 infection in Thailand (from March 2004), with fever and diarrhoea but no respiratory symptoms. The report suggests that the clinical spectrum of disease may be broader than previously thought. 12 Aug 2004 Viet Nam reports 3 new human cases, all fatal (first cases since February). Dates of hospital admission are from 19 July to 8 August. 19 Aug 2004 Malaysia (peninsular) first reports H5N1 in poultry. Outbreaks and positive avian surveillance samples continue to be reported through September Aug 2004 Research 6 2 Sep 2004 Research 7 Chinese researchers report preliminary findings of H5N1 infection in pigs. No evidence suggests that pig infections are widespread, and the finding appears to have limited epidemiological significance. Research shows that domestic cats experimentally infected with H5N1 develop severe disease and can spread infection to other cats. Prior to this research, domestic cats were considered resistant to disease from all influenza A viruses. 7 Sep 2004 A 4th fatal human case is reported in Viet Nam. 9 Sep 2004 Thailand confirms its third fatal case of human infection. 28 Sep 2004 Thailand confirms 2 further human cases. 4 Oct 2004 Thailand confirms its 4th human case. 18 Oct 2004 Two healthy Hawk-Eagles smuggled from Thailand are seized at Brussels International Airport. HPAI H5N1 is isolated. 20 Oct 2004 A second outbreak of HPAI H5N1 in zoo tigers in Thailand occurs. It is attributed to tigers having been fed fresh chicken carcasses and whole chickens. Altogether, 3

4 147 tigers out of a population of 441 die or are euthanized. No virus is detected in birds in zoo or local area. 25 Oct 2004 Thailand confirms its 5th human case. 29 Oct 2004 Research 8 Research confirms that domestic ducks can act as silent reservoirs, excreting large quantities of highly pathogenic virus yet showing few if any signs of illness. 3 Nov 2004 Hong Kong SAR reports H5N1 in a dead wild bird (last report January 2004). Dec 2004 Poultry outbreaks continue in Indonesia, Thailand, and Viet Nam and possibly also in Cambodia and Lao PDR. Reported outbreaks continue more or less continuously in Indonesia through August 2006, in Thailand through November 2005, and in Viet Nam though December Dec 2004 Viet Nam confirms a new case. 6 Jan 2005 Viet Nam confirms 2 further cases. 14 Jan 2005 Hong Kong reports H5N1 in one wild bird as part of routine surveillance. 27 Jan 2005 Research 9 Total number of human cases in Viet Nam rises to 6. Sporadic cases continue to be reported over the coming months, making Viet Nam the hardest hit country. Research concludes that a girl in Thailand probably passed the virus to at least her mother in September 2004, causing fatal disease. This is the first published account of probable secondary human transmission, resulting in severe disease, of any avian influenza virus. 2 Feb 2005 Cambodia confirms its first human case, which is fatal. 17 Feb 2005 Research 10 Research retrospectively identifies at least one fatal atypical case in Viet Nam (from Feb 2004), presenting with diarrhoea and encephalitis, but normal chest X-rays. 29 Mar 2005 Cambodia confirms its 2nd human case, also fatal. 12 Apr 2005 Cambodia confirms its 3rd human case, also fatal. 30 Apr 2005 Wild birds begin dying at Qinghai Lake in central China, where hundreds of thousands of migratory birds congregate. Altogether, 6,345 birds from different species die in the coming weeks. This is the first reported instance of any HPAI causing mass die-offs in wild birds. 4 May 2005 Cambodia confirms its 4th human case, 4

5 8 Jun 2005 China reports poultry outbreak in Xinjiang Autonomous Region. Reports continue from several provinces, through February Jun 2005 Japan reports LPAI H5N2 in poultry, which continues to be detected through April Source remains unconfirmed, though one rumour suggests the strain was introduced via improperly prepared vaccine. also fatal. 30 Jun 2005 A WHO investigative team finds no evidence that H5N1 has increased its transmissibility in humans in Viet Nam. 6 Jul 2005 Research 11 Research on viruses isolated from dead birds in Qinghai Lake suggests the outbreak was caused by a new H5N1 variant that may be more lethal to wild birds and experimentally infected mice. 7 Jul 2005 The Philippines reports LPAI (likely an H9) in poultry. 14 Jul 2005 Research 12 Research on viruses isolated from dead birds in Qinghai Lake demonstrates transmission of the virus among migratory geese and suggests that the virus may be carried along winter migratory routes. 15 Jul 2005 H5N1 is detected in three captive Owston s palm civets that died in late June in a Vietnamese wildlife preserve. This is the first reported infection of this species with the virus. The civets were not fed chicken and the source of infection remains unknown. 21 Jul 2005 Indonesia confirms its first human case. Infection in two other family members is considered likely, but cannot be laboratory confirmed. Subsequent investigation is unable to determine the source of infection. Virus has been circulating in poultry in Indonesia since February Jul 2005 Russia reports first outbreaks of H5N1, in poultry in the Novosibirsk region. Dead migratory birds are reported in the vicinity of outbreaks. From 23 July- 22 December 2005, a total of 62 sites in 10 regions are confirmed as HPAI H5N1- positive. 29 Jul 2005 Kazakhstan reports first H5N1 in poultry in areas adjacent to Siberia. Dead migratory birds are reported in the vicinity of outbreaks. 5

6 2 Aug 2005 Indonesia reports H5N1 in poultry and pigs during surveillance in the region where the recent human cases lived (Tangerang district, Banten province, West Java). 10 Aug 2005 China reports additional outbreaks in several provinces through February Vaccination is initiated in affected regions using an H5N2 monovalent inactivated vaccine. Mongolia reports deaths in 89 migratory birds at two lakes in Northern Mongolia. H5N1 is subsequently identified in 4 of the birds. 16 Sep 2005 Indonesia confirms its 2nd case. 22 Sep 2005 Indonesia confirms its 3rd case. 29 Sep 2005 Indonesia confirms its 4th case. Research 13 Research describes the clinical features of H5N1 infection and reviews recommendations for the management of cases. Oct 2005 Research 14 6 Oct 2005 Highly pathogenic H5N1 is first reported in poultry in Turkey. 7 Oct 2005 Highly pathogenic H5N1 is first reported in poultry in Romania. Reports continue through July Research on the evolution of human and animal viruses circulating in Asia in 2005 suggests that several amino acids located near the receptor-binding site are undergoing change, some of which may affect antigenicity or transmissibility. 15, 16 Research Research describes reconstruction of the lethal 1918 pandemic virus, concludes that this virus was entirely avian, and finds some similarities with H5N1. 10 Oct 2005 Indonesia confirms its 5th human case. 20 Oct 2005 Taiwan, China reports the detection of highly pathogenic H5N1 in a cargo of exotic songbirds smuggled from mainland China. 21 Oct 2005 Croatia first reports H5N1 in wild birds (migratory swans). H5N1 continues to be reported in wild birds on routine surveillance, through April Oct 2005 The United Kingdom reports highly pathogenic H5N1 in an imported parrot, held in quarantine, that died 3 days earlier. Thailand confirms its 18th human case (the first human case in Thailand since October Oct 2005 Thailand confirms its 19th human case, and Indonesia confirms its 6th and 7th human cases. 6

7 9 Nov 2005 Viet Nam confirms its 65th human case (its first human case since July 2005). 11 Nov 2005 Kuwait detects highly pathogenic H5N1 in a single migratory flamingo, marking the first report of this disease in the Gulf region. 17 Nov 2005 China confirms its first two human cases, from Hunan and Anhui provinces (does not include the case in 2003, confirmed retrospectively). 24 Nov 2005 China confirms its third human case, from Anhui province. Sporadic cases continue to be reported in the coming weeks. 2 Dec 2005 Ukraine reports its first H5N1 outbreak in domestic birds in Crimea. Outbreaks continue to be reported through February Dec 2005 Turkey reports a new outbreak in poultry in the eastern province of Igdir. Through April 2006, additional outbreaks are reported in primarily backyard poultry in 11 of the country s 81 provinces. Wild birds are also reported to be infected. Control measures include culling of poultry in Iraqi Kurdistan and all backyard poultry in Iran within 10 km of the Turkish border. Vaccination is prohibited. Jan 2006 Qinghai Lake-like H5N1 viruses are reportedly isolated from cats in Northern Iraq. 17 By the end of 2005, Indonesia has confirmed a total of 20 cases in humans. 5 Jan 2006 Turkey confirms its first two human cases. Sporadic cases continue to be reported in the coming weeks, but rapidly end. Viruses are similar to those currently circulating in birds. 20 Jan 2006 Hong Kong reports H5N1 in a dead wild bird (first report since January 2005), and H5N1 reports in wild birds (and in 2 chickens) continue through March These viruses all belong to H5N1 genotype V, which has previously been recorded in southern China, Japan and South Korea. 30 Jan 2006 Iraq confirms its first human case, in a 15-year-old girl in Sulaimaniyah (onset date 9 January 2006). 1 Feb 2006 Iraq reports its first outbreak of H5N1, in backyard flocks in same village where human case detected. 3 Feb 2006 Bulgaria first reports H5N1 in wild birds (swans). 8 Feb 2006 Nigeria first reports H5N1 in poultry. 7

8 This is the first report of the virus in Africa. Outbreaks in poultry and ornamental birds are reported through March Feb 2006 Greece first reports H5N1 in wild birds (swans). Additional reports in wild birds through March Feb 2006 Italy first reports H5N1 in wild birds. 12 Feb 2006 Slovenia first reports H5N1 in a wild bird (swan). A total of 48 dead wild birds are reported through March Feb 2006 Iran first reports H5N1 in wild birds (swans) found dead on routine surveillance. Russia reports H5N1 outbreaks (at large commercial farms) in the Caucasus region, near the border with Azerbaijan. Further outbreaks are reported in backyard poultry, pigeons, and wild birds in Tyva Republic, Altaj, Tomsk, Omsk and Novosibirsk regions through July (first outbreak reported since October 2005) China confirms its 12th case and 8th fatality. Some human cases have occurred in areas with no reported outbreaks in poultry. Indonesia confirms its 25th case and 18th fatality. 14 Feb 2006 Germany first reports H5N1 in wild birds (swans). Reports of H5N1 in wild birds on routine surveillance continue through April Feb 2006 Egypt reports its first H5N1 in domestic poultry (since 1965). Outbreaks continue to be reported through December France first reports H5N1 in a wild duck (followed by additional reports in other wild birds). Iraq confirms its second human case. 18 Feb 2006 India first reports H5N1 in domestic poultry. Reported outbreaks continue through April Austria first reports H5N1 in wild birds (swans). Austria continues to find H5N1 in some wild birds on routine surveillance, until April Feb 2006 Malaysia reports H5N1 in a flock of freerange poultry (last reported September 2004). Outbreaks reported through March Feb 2006 Bosnia-Herzegovina and Slovakia each first report H5N1 in wild birds (migratory swans). 21 Feb 2006 Hungary first reports H5N1 in wild birds (swans). Research 18 Studies of H5N1 viruses show that multiple genetically and antigenically distinct sublineages of the virus are now established in poultry in parts of Asia. 8

9 Poultry-to-poultry transmission is thought to sustain endemicity of the virus in this region. H5N1 virus is isolated from apparently healthy migratory birds in southern China, suggesting that migratory birds can carry the virus over long distances. 23 Mar 2006 West Bank/Gaza Strip first reports H5N1 in poultry. Outbreaks reported through April Feb 2006 Azerbaijan first reports H5N1 in migratory birds. H5N1 is later also confirmed in poultry. Georgia first reports H5N1in wild birds (swans). 25 Feb 2006 France first reports H5N1 in a single turkey farm, marking the first appearance of this disease in domestic poultry in the EU. Had previously been identified in wild birds in France. 27 Feb 2006 Niger first reports H5N1 in domestic poultry (area near border with affected states of northern Nigeria) Pakistan first reports H5N1 in poultry. Outbreaks are reported through July Feb 2006 Germany reports H5N1 infection in a dead domestic cat on the Isle of Ruegen. Two more cats on the Island are found to be infected in March. Cats are thought to have been exposed by eating infected birds. 1 Mar 2006 Serbia-Montenegro first reports H5N1 in wild birds (swans). Switzerland first reports H5N1 in a dead wild bird. Additional wild birds are reported positive in March and April from various locations throughout the country on routine surveillance. 6 Mar 2006 Poland first reports H5N1 in wild birds (swans). Reports continue through May Mar 2006 Albania first reports H5N1 in poultry (chickens). Austria reports H5N1 in 3 domestic cats in an animal shelter. 9 Mar 2006 Germany reports H5N1 infection in a stone marten on the Isle of Ruegen, marking the first documented infection of this species with an avian influenza virus. Myanmar reports H5N1 in poultry (first since 1996). 11 Mar 2006 Cameroon first reports H5N1 in domestic ducks. 9

10 13 Mar 2006 Serbia-Montenegro first reports H5N1 in poultry (1 rooster). Had been previously reported in wild birds. 14 Mar 2006 Denmark first reports H5N1 in a wild bird. Reports in wild birds continue through May of Mar 2006 Afghanistan first reports H5N1 in poultry and a crow. 16 Mar 2006 Israel first reports H5N1 in poultry. Sweden first reports H5N1 in 36 dead wild birds tested in February and March (no increase in overall wild bird mortality) 17 Mar 2006 Khazakstan reports H5N1 in wild birds (first since August 2005) Sweden first reports HPAI H5 (no N type given) in poultry in a game bird holding within the surveillance zone set up in response to detection of H5N1 in wild birds. Iraq has its third human case, in a 3-year- -old boy (case retrospectively confirmed in September, 2006) Azerbaijan confirms its first human cases (onset dates from mid-february 2006). 20 Mar 2006 Egypt confirms its first human case in a 30-year-old woman from Qalubiya (onset early March 2006). 23 Mar 2006 Cambodia reports its first outbreak in poultry since December Outbreaks continue to be reported through fall Jordan first reports H5N1 in poultry. 27 Mar 2006 Czech Republic first reports H5N1 in a wild bird (swan). Reports in wild swans continue through May Sweden detects H5N1 in a wild mink in southern Sweden in an area where wild birds cases have been detected. 3 Apr 2006 Burkina Faso first reports H5N1 in poultry (guineafowl). 5 Apr 2006 Germany first reports H5N1 in poultry, in turkeys on a single farm (previously reported in wild birds). 6 Apr 2006 United Kingdom first reports H5N1 in a single wild bird (swan). 19, 20 Research Two research groups publish findings that may help explain why the H5N1 virus does not easily infect humans or like normal seasonal influenza spread readily by coughing or sneezing. Whereas human influenza viruses attach themselves to molecules in cells lining the nose and throat, avian viruses prefer to bind to molecules located deep in the lungs. Such findings are consistent with the clinical picture of H5N1 infection, in which most patients present with symptoms of infection in the lower respiratory tract, with rapid progression to pneumonia. Cambodia confirms its 6th human case in a 12-year-old boy from Prey Vang (onset date 29 March 2006) (first human case in Cambodia since April 2005). 10

11 12 Apr 2006 Indonesia confirms its 31st human case in a 23-year-old man from West Java (onset date 20 March 2006). 13 Apr 2006 Egypt confirms its 12th human case in a 18-year-old woman from Minufiyah (onset date 5 April 2006). 17 Apr 2006 Sudan first reports H5N1 in poultry (both intensive and backyard systems). Additional outbreaks reported through October Apr 2006 China reports H5N1 in wild aquatic and other birds in Qinghai and Tibet regions. Côte d Ivoire first reports H5N1 in poultry and a wild bird. Outbreaks continue to be reported through July Apr 2006 Djibouti reports its first case of H5N1 in poultry. China confirms its 17th human case in an 21-year-old man from Hubei (onset date 1 April 2006). Indonesia confirms its 32nd human case in a 24-year-old man from Banten (onset date 29 March 2006). 27 Apr 2006 China confirms its 18th human case in an 8-year-old girl from Sichuan (onset date 16 April 2006). 4 May 2006 Mongolia reports H5N1 in dead wild birds on routine surveillance through June 2006 (last report August 2005). Egypt confirms its 13th human case in a 27-year-old woman from Cairo (onset date 15 April 2006). 8 May 2006 Indonesia confirms its 33rd human case in a 30-year-old man from Jakarta (onset date 17 April 2006) 9 May 2006 Ukraine first reports HPAI H5 in wild birds (previously reported in poultry) 12 May 2006 Djibouti confirms its first human case in a 2-year-old girl from Arta (onset date 23 April 2006). 18 May 2006 Denmark reports its first outbreak of H5N1 HPAI in domestic poultry (was previously reported in wild birds). An outbreak of H5N2 LPAI was also reported during this period. Egypt confirms its 14th case in a 75-year- -old woman from Al Minya (onset date 11 May 2006). Indonesia reports the largest family cluster in any country to date, with 7 confirmed cases (the 34th through 39th and the 42nd) from 4 households in the Karo district of North Sumatra. The index case (unconfirmed) develops symptoms on 24 Apr, the last case dies on 22 May. Cases include the index case's 2 sons, (aged 15 and 17 years), her 10-year-old nephew, her 2 brothers (aged 25 and 32 years), her 28-year-old sister, and this sister's 18-month-old daughter. Disease does not spread beyond the extended family. Limited human to human transmission can not be ruled out. Viruses do not show any significant genetic mutations or reassortment. Indonesia also confirms its 40th human case, in a 38-year-old woman from East 11

12 Java (onset date 2 May 2006). 19 May 2006 Indonesia confirms its 41st human case in a 12-year-old boy from East Jakarta (onset date 7 May 2006). 29 May 2006 Indonesia confirms its 43rd - 48th human cases in an 18-year-old man from East Java (onset date 6 May 2006), a 10-yearold girl and her 18-year--old brother from West Java (both with onset date 16 May 2006), a 39-year-old man from Jakarta (onset date 9 May 2006), a 43-year-old man from Jakarta (onset date 6 May 2006), and a 15-year-old girl from West Sumatra (onset date 17 May 2006). All 6 cases are unrelated to the family cluster in Karo, North Sumatra. 4 Jun 2006 China reports its first cases in poultry since February Outbreaks reported from various provinces through October Jun 2006 Indonesia confirms its 49th human case in a 15-year-old boy from West Java (onset date 26 May 2006). 9 Jun 2006 Hungary reports its first H5N1 in poultry (previously reported in wild birds). 15 Jun 2006 Ukraine reports H5N1 in poultry (first report since February 2006), first reported in wild birds in May Jun 2006 Indonesia confirms its 50th human case in a 7-year-old girl from Banten (onset date 26 May 2006). China confirms its 19th human case, in a 31-year-old man from Guandong (onset date 3 June 2006). 20 Jun 2006 Indonesia confirms its 51st human case in a 13-year-old boy from Jakarta (onset date 9 June 2006). 30 Jun 2006 Research 21 The first analysis of epidemiological data on all 205 laboratory-confirmed H5N1 cases officially reported to WHO from Dec 2003 to 30 Apr 2006 is published by WHO. 4 Jul 2006 Indonesia confirms its 52nd human case in a 5-year-old boy from East Java (onset date 8 June 2006). 7 Jul 2006 Spain first reports H5N1 in a single wild shore bird (grebe) in northern region. 14 Jul 2006 Indonesia confirms its 53rd human case in a 3-year-old girl from Jakarta (onset date 23 June 2006). 20 Jul 2006 Indonesia confirms its 54th human case in a 44-year-old man from Jakarta (onset date 24 June 2006). 26 Jul 2006 Thailand reports two H5N1 outbreaks in poultry (in Phichit and Nakhon Phanom Thailand confirms its 23rd human case in a 17-year-old boy from Phichit in 12

13 provinces). These are the first reported in more than 8 months. Poultry vaccination remains prohibited. 27 Jul 2006 Lao PDR reports H5N1 in poultry (first reported since January 2004) 3 Aug 2006 H5N1 is detected in a captive zoo swan in Germany (previously reported in both wild and domestic birds) 30 Aug 2006 Viet Nam reports H5N1 in unvaccinated duck flocks and market ducks on routine surveillance. Ducks did not show clinical signs. (First report since December 2005) northern Thailand (onset date 15 July 2006) (the first human case in Thailand in 2006). 7 Aug 2006 Thailand confirms its 24th human case in a 27-year-old man from Uthai Thani in central Thailand (onset date 24 July 2006). 8 Aug 2006 China retrospectively confirms its 20th human case in a 24-year-old man from Beijing (onset date 25 November 2003) who died. This case becomes the first confirmed case of HPAI H5N1 infection in the present outbreak. The case was initially attributed to SARS. Indonesia confirms its 55th human case in a 16-year-old boy from West Java (onset date 26 July 2006), and becomes the country with the most human deaths (n=43) from H5N1 HPAI infection, surpassing Viet Nam. A system for unified H5N1 nomenclature, developed by the WHO/OIE/FAO Evolution Working Group, is posted on the WHO website ( disease/avian_influenza/guidelines/ nomenclature/en/index.html) and the OFFLU website ( 9 Aug 2006 Indonesia confirms its 56th human case in an 17-year-old girl from Jakarta (onset date 28 July 2006). 14 Aug 2006 Indonesia confirms its 57th human case in an 17-year-old boy from West Java (Cikelet/Garut Cluster) (onset date 26 July 2006). 14 Aug 2006 The USA detects LPAI H5N1 in wild mute swans in Michigan. China confirms its 21st human case in a 62-year-old man from the Uygur Autonomous Region in north-western China (onset date 19 June 2006). 17 Aug 2006 Indonesia confirms its 58th human case in an 9-year-old girl from West Java (Cikelet/Garut Cluster) (onset date 1 August 2006). 21 Aug 2006 Indonesia confirms its 59th human case in an 35-year-old woman from West Java (Cikelet/Garut Cluster) (onset date 8 13

14 August 2006). In this cluster, there was no evidence of human to human transmission, poultry deaths were possibly linked with live chickens returning to village from live animal market, and there were possible additional human cases that were not confirmed. 23 Aug 2006 Indonesia confirms its 60th human case in an 6-year-old girl from West Java (onset date 6 August 2006). 2 Sep 2006 The USA detects LPAI H5N1 in wild ducks in Pennsylvania and Maryland. 8 Sep 2006 Indonesia confirms its 61st human case in an 14-year-old girl from South Sulawesi (onset date 18 June 2006). Due to revisions to the WHO case definition, two cases are retrospectively confirmed in Indonesia: The 62nd in an 8-year-old girl from Banten (onset date 24 June 2005) and the 63rd in a 45-yearold man from central Java (onset date 25 November 2005). 14 Sep 2006 Indonesia confirms its 64th human case in a 5-year-old boy from West Java (onset date 4 March 2006)and (through follow up testing) its 65th human case in a 27-year-old male from West Sumatra (onset date 28 May 2006) (brother of 15- year-old girl; was possible human to human transmission). 25 Sep 2006 Indonesia confirms its 66th human case in an 11-year-old boy from East Java (onset date 16 September 2006)and its 67th human case in a 9-year-old boy from Jakarta (onset date 13 September 2006). 27 Sep 2006 Indonesia confirms its 68th human case in a 20-year-old man from West Java (onset date 17 September 2006). 27 Sep 2006 Thailand confirms its 25th human case, in a 59-year-old man from Nong Bua Lam Phu Province in Northeastern Thailand (onset date 14 July 2006). 3 Oct 2006 Indonesia confirms its 69th human case in a 21-year-old woman from East Java (onset date 19 September 2006) (the sister of the 66 th case). 11 Oct 2006 Egypt confirms its 15th human case, in a 39-year-old woman from Gharbiya (onset date 30 September 2006) (the first human case since May 2006). 16 Oct 2006 Indonesia confirms its 70th human case in a 67-year-old woman from West Java (onset date 3 October 2006), its 71st human case in a 11-year-old boy from Jakarta (onset date 2 October 2006), and 14

15 its 72nd human case in a 27-year-old woman from Central Java (onset date 8 October 2006). 30 Oct 2006 Research 22 A surveillance study of H5N1 isolates from poultry in southern China confirms that subtypes continue to emerge and their relative prevalence continues to change. 13 Nov 2006 Indonesia confirms its 73rd human case in a 35-year-old woman from Banten (onset date 7 November 2006) and its 74th human case, in a 30 month old boy from West Java (onset date 10 November 2006). 22 Nov 2006 Republic of Korea reports H5N1 in poultry (first since September 2004). Outbreaks continue to be reported. 10 Dec 2006 China confirms its 22 nd human case in a 37-year-old man from Anhui (onset date 10 December 2006) (retrospectively confirmed on 10 January 2007). 14 Dec 2006 In an effort to contain the disease, live animal markets in Beijing, China are permanently closed. 19 Dec 2006 Viet Nam reports H5N1 in unvaccinated poultry (first report since August 2006). Outbreaks become widespread in the southern part of the country. 27 Dec 2006 Egypt confirms its 16th, 17th, and 18th human cases in an extended family in Gharbiyah (onset dates 9-15 December 2006). The isolated viruses had a genetic mutation, linked in laboratory testing to moderately reduced susceptibility to oseltamivir. WHO does not change treatment recommendations. 8 Jan 2007 Indonesia confirms its 75th human case, in a 14-year-old boy from West Jakarta (onset date 31 December 2006). 9 Jan 2007 Indonesia confirms its 76th human case, in a 37-year-old woman from Banten (onset date 1 January 2007). 12 Jan 2007 Indonesia confirms its 77th human case, in a 22-year-old woman from Banten (onset date 3 January 2007). 13 Jan 2007 Japan reports H5N1 in poultry (first since March 2004). 15 Jan 2007 Hong Kong reports H5N1 in dead wild birds (first since January 2006). Indonesia confirms its 78th human case, in a 27-year-old woman from South Jakarta (onset date 6 January 2007) and its 79th human case, in a 18-year-old boy from Banten (onset date 10 January 2007) (son of the 76th case). 15

16 16 Jan 2007 Thailand reports H5N1 in poultry during routine intensive surveillance (first since July 2006). Vaccination remains prohibited. 17 Jan 2007 Viet Nam reports continued H5N1infection in farmed and village poultry 22 Jan 2007 Egypt confirms its 19th human case, in a 27-year-old woman from Beni Sweif (onset date 9 January 2007). 22 Jan 2007 Indonesia confirms its 80th human case, in a 32-year-old woman from West Java (onset date 8 January 2007). 24 Jan 2007 Hungary reports H5N1 in poultry (first since June 2006). 25 Jan 2007 Indonesia confirms its 81st human case, in a 6-year-old girl from Central Java (onset date 8 January 2007). 26 Jan 2007 Russia reports H5N1 in poultry (first report since July 2006). 27 Jan 2007 The United Kingdom reports H5N1 on a commercial turkey farm (first ever report in poultry, reported in wild birds in April 2006). Only a single outbreak occurs. 28 Jan 2007 In an effort to curb virus spread, Indonesia institutes a poultry ban for the entire island of Java, and bans backyard poultry in 9 provinces. 31 Jan 2007 Nigeria confirms its first human case, in a 22-year-old woman from Lagos (onset date 8 January 2007). 1 Feb 2007 Pakistan reports H5N1 in poultry (first since July 2006). 6 Feb 2007 Egypt confirms its 20th human case, in a 17-year-old girl from Fayoum (onset date 25 January 2007). 9 Feb 2007 Research 23 The second WHO analysis of epidemiological data on WHO-confirmed human cases of avian influenza A (H5N1) infection, 25 November November 2006 is published by WHO. 9 Feb 2007 Turkey reports H5N1 in backyard poultry (first report since April 2006). 15 Feb 2007 Egypt confirms its 21st human case, in a 37-year-old woman from Fayoum (onset date 10 February 2007). 19 Feb 2007 Egypt confirms its 22nd human case, in a 5-year-old boy from Sharkia (onset date 14 February 2007). 20 Feb 2007 Ongoing H5N1 outbreaks in poultry in several states of Nigeria are reported by FAO Feb 2007 Lao PDR reports H5N1 in poultry (first reported since July 2006). 22 Feb 2007 Afghanistan reports H5N1 in backyard poultry and farms (first report since 16

17 March 2006). 26 Feb 2007 Kuwait reports H5N1 in poultry in backyards, on farms, and in a zoo (first report in birds since November First ever report in poultry). 28 Feb 2007 Myanmar reports H5N1 in poultry (first report since April 2006). Lao PDR confirms its first human case, in a 15-year-old girl from Vientiane (onset date 10 February 2007). Egypt confirms its 23rd human case, in a 4-year-old girl from Dakahlea (onset date 25 February 2007). China confirms its 23rd human case, in a 44-year-old woman from Fujian (onset date 18 February 2007). 6 Mar 2007 China reports H5N1 in poultry (first report since September 2006). 12 Mar 2007 Egypt confirms its 24th human case, in a 4-year-old boy from Dakahlea (onset date 7 March 2007). 16 Mar 2007 Lao PDR confirms its second human case, in a 42-year-old woman from Vientiane Province (onset date 26 February 2007). 19 Mar 2007 Egypt confirms its 25 th human case, in a 10-year-old girl from Aswan (onset date 13 March 2007). 20 Mar 2007 Egypt confirms its 26th human case, in a 2-year-old boy from Aswan (onset date 15 March 2007). China confirms avian influenza H9N2 infection in a 9-month-old girl with mild signs of disease. 26 Mar 2007 Egypt confirms its 27th human case, in a 3-year-old girl from Aswan (onset date 22 March 2007). No epidemiological link is evident among the three recent cases from Aswan. 27 Mar 2007 During high level talks in Jakarta, Indonesia announces that it will resume sharing H5N1 AI virus with the international community. 28 Mar 2007 Egypt confirms its 28th human case, in a 6-year-old girl from Qena, and its 29th human case, in a 5-year-old boy from Menia. (both had onset date 26 March 2007) 29 Mar 2007 China confirms its 24th human case, in a 16-year-old boy from Anhui (onset date 17 March 2007). 30 Mar 2007 Bangladesh reports H5N1 in poultry (first ever in Bangladesh). 2 Apr 2007 Saudi Arabia reports H5N1 in poultry (first ever in Saudi Arabia) Egypt confirms its 30th human case, in a 4-year-old boy from Qena (brother of the 28th case), its 31st human case, in a 7- year-old boy from Sohag (both with onset date 26 March 2007), and its 32nd human case, in a 4-year-old girl from Qalyoubia (onset date 29 March 2007). According to the Ministry of Health in Indonesia, cases of H5N1 infection in humans continue to occur. 10 Apr 2007 Cambodia confirms its 7th human case, 17

18 in a 13-year-old girl from Kampong Cham (onset date 2 April 2007) (first human case since March 2006). Egypt confirms its 33rd human case, in a 2-year-old girl from Menia (onset date 3 April 2007) and its 34th human case in a 15-year-old girl from Cairo (onset date 30 March 2007). 12 Apr 2007 Cambodia reports H5N1 in village poultry (first report in poultry since August 2006). 3 May 2007 Ghana reports H5N1 in poultry (first ever in Ghana). 16 May 2007 WHO retrospectively confirms 15 human cases and 13 deaths in Indonesia, bringing the total confirmed human cases to 96, with 76 deaths. Cases had onset dates between 25 January and 3 May 2007, and had been initially confirmed by the Indonesian Ministry of Health. 23 May 2007 A resolution on international sharing of influenza viruses is reached at the WHO World Health Assembly in Geneva. 24 May 2007 Viet Nam reports multiple outbreaks in unvaccinated poultry (primarily ducks) from several provinces throughout the country. Indonesia confirms its 97th human case, in a 5-year-old girl from Central Java (onset date 8 May 2007). Bangladesh reports multiple outbreaks in poultry from additional provinces throughout the country. 25 May 2007 The United Kingdom Health Protection Agency reports at least 4 human infections with low pathogenic avian influenza H7N2. The cases are associated with reported H7N2 infections in poultry. 30 May 2007 China confirms its 25th human case, in a 19-year-old soldier stationed in Fujian province (onset date 9 May 2007). 31 May 2007 Indonesia confirms its 98th human case, in a 45-year-old man from Central Java (onset date 17 May 2007). 2 Jun 2007 Malaysia reports its first outbreak in poultry since March, 2006 (in village chickens). 6 Jun 2007 Indonesia confirms its 99th human case, in a 16- year-old girl from Central Java (onset date 21 May 2007). 11 June 2007 Egypt confirms its 35th human case, in a 10-year-old girl from Qena (onset date 1 June 2007). 12 Jun 2007 Egypt confirms its 36th human case, in a 4-year-old girl from Qena (onset date 7 June 2007) (no epidemiological link between these two most recent Egyptian cases). 15 Jun 2007 Indonesia confirms its 100th human case, in a 27- year-old man from Riau (onset date 3 June 2007). 22 Jun 2007 Czech Republic reports its first outbreak ever in poultry (in commercial turkeys). 18

19 Togo reports its first outbreak ever in poultry (in commercial chickens). 25 June 2007 Egypt confirms its 37th human case, in a 4-year-old boy from Qena (onset date 20 June 2007). 26 Jun 2007 Germany reports H5N1 in wild birds found dead (first reports since detected in commercial poultry in April 2006). 29 Jun 2007 Czech Republic reports H5N1 in a dead mute swan (first in wild birds since May 2006). Indonesia confirms its 101st human case, in a 3- year-old girl from Riau (onset date 18 June 2007). Viet Nam confirms it first human cases since November, 2005, in a 29-year-old man from Vinh Phuc (onset date 10 May 2007) and a 19-year-old man from Thai Nguyen (onset date 20 May 2007). No epidemiological link between these two cases has been identified. There have been 95 human cases in Viet Nam since Jul 2007 France reports H5N1 in wild swans found dead (first report since detected in commercial turkeys in February 2006). 6 Jul 2007 Germany reports H5N1 in a dead domestic goose 11 Jul 2007 Indonesia confirms its 102nd human case, in a 6-year-old girl from Banten (onset date 23 June 2007). 15 Jul 2007 Bangladesh Ministry of Agriculture reports continued H5N1 outbreaks in commercial and backyard poultry. 25 Jul 2007 Egypt confirms its 38th human case, in a 25-year-old woman from Damietta (onset date 20 July 2007). 26 Jul 2007 India reports H5N1 in backyard poultry (first report since April 2006). 14 Aug 2007 Indonesia confirms its 103rd human case, in a 29-year-old woman from Bali (onset date 3 August 2007). 15 Aug 2007 Research 25 A study describing the epidemiology of 54 human cases of H5N1 infection in Indonesia is published. Conclusions included that 76% of cases were associated with poultry contact, and the source of infection was not identified in 24% of cases. 16 Aug 2007 Indonesia confirms its 104th human case, in a 17-year-old woman from Banten (onset date 9 August 2007). 23 Aug 2007 Indonesia confirms its 105th human case, in a 28-year-old woman from Bali (onset date 14 August 2007). 30 Aug 2007 The WHO criteria for accepting confirmed cases of A(H5) infection are amended. 31 Aug 2007 Based on amended acceptance criteria, Viet Nam retrospectively confirms its 96th through 100th cases, in a 28-year-old woman from Ha Nam (onset date 3 June 19

20 2007), a 29-year-old man (onset date 30 May 2007) and a 15-year-old boy (onset date 27 July 2007) from Thanh Hoa, and a 20-year-old man (onset date 2 June 2007) and a 22-year-old woman (onset date 20 July 2007) from Ha Tay. 07 Sept 2007 Russia reports H5N1 in poultry (first report since January 2007). 10 Sept 2007 Indonesia confirms its 106th human case, in a 33-year-old man from Riau (onset date 25 August 2007). 15 Sept 2007 China reports H5N1 in commercial ducks in Guandong (first report since May 2007). 2 Oct 2007 Indonesia confirms its 107th human case, in a 21-year-old man from Jakarta (onset date 18 September 2007). 8 Oct 2007 Indonesia confirms its 108th human case, in a 44-year-old woman from Riau (onset date 1 October 2007). 11 Oct 2007 Viet Nam reports H5N1 in unvaccinated ducks in Tra Vinh (first report since August 2007). 12 Oct 2007 Indonesia confirms its 109th human case, in a 12-year-old boy from Banten (onset date 30 September 2007). 15 Oct 2007 According to FAO 26, H5N1 has caused recent outbreaks in poultry in 19 districts in Bangladesh and 4 districts in Indonesia, and in commercial poultry in Ogun, Nigeria (in September). 24 Oct 2007 Myanmar reports H5N1 in commercial poultry in Bago (first report since August 2007). 25 Oct 2007 Indonesia confirms its 110th human case, in a 5-year-old girl from Banten (onset 31 Oct 2007 Viet Nam reports H5N1 in unvaccinated poultry in 3 additional provinces. date 14 October 2007). Indonesia confirms its 111th human case, in a 3-year-old boy from Banten. Both this case and the 110th case became ill on 14 October, but no epidemiological link between them has been identified. 5 Nov 2007 Indonesia confirms its 112th human case, in a 30-year-old woman from Banten (onset date 23 October 2007). 12 Nov 2007 Indonesia confirms its 113th human case, in a 31-year-old man from Riau (onset date 31 October 2007). 13 Nov 2007 UK reports H5N1 in a flock of free-range turkeys in England (first since January 2007). 19 Nov 2007 Saudi Arabia reports H5N1 in commercial chickens in four areas of Ar Riyad. 22 Nov 2007 Pakistan reports H5N1 in commercial, poultry in the North West Frontier (first outbreak in poultry since July 2007). 23 Nov 2007 Myanmar reports H5N1 in backyard poultry in a new province (Shan state) 27 Nov 2007 Romania reports H5N1in backyard 20

21 poultry in Tulcea (first outbreak in poultry since May 2006). 3 Dec 2007 Poland reports H5N1 in young turkeys in Mazowieckie (first outbreak ever in poultry, last H5N1 reported in a wild swan in May 2006). Egypt retrospectively reports 579 outbreaks of H5N1 in birds from 23 March 2006 through 24 November Dec 2007 China confirms its 26th human case, in a 24-year-old man from Jiangsu (onset date 24 November 2007). 5 Dec 2007 Benin reports highly pathogenic avian influenza (not confirmed as H5N1) in poultry in Cotonou and Adjara (first HPAI outbreak ever reported in Benin). Later reported as H5N1by FAO Dec 2007 China confirms its 27th human case, in a 52-year-old man from Jiangsu (onset date 3 December 2007), who is the father of the 26th case. 12 Dec 2007 Russia reports H5N1 in poultry in Rostovskaya (first outbreak in poultry since September 2007). Pakistan reports additional H5N1 outbreaks in commercial poultry in North West Frontier and Punjab provinces. Poland reports H5N1 in birds in a second province (Warminsko-Mazurskie). Indonesia confirms its 114th human case, in a 28-year-old woman from Banten (onset date 1 December 2007). 13 Dec 2007 Indonesia confirms its 115th human case, in a 47-year-old man from Banten (onset date 2 December 2007). 14 Dec 2007 Myanmar confirms its first human case, in a 7-year-old girl from Shan State (onset date 21 November 2007). 15 Dec 2007 Pakistan informs WHO of 8 people in the North West Frontier Province that have tested positive for H5N1 in the national reference laboratory. These are the first suspected human cases ever reported in Pakistan. The presence of virus was confirmed in samples from one of these patients, a 25-year-old man from Peshawar (onset date 21 November). 17 Dec 2007 According to FAO 27, H5N1has continued to cause outbreaks in poultry in areas of Indonesia (Bali, Java, Sulawesi, Sumatra) and Viet Nam (Tra Vinh, Cao Bang, Quang Tri) in November and December. 26 Dec 2007 Indonesia confirms its 116th human case, in a 24-year-old woman from Jakarta (onset date 14 December 2007). Egypt confirms its 39th human case, in a 25-year-old woman from Beni Sweif (onset date 23 December 2007). This is the first case confirmed by Egypt since July Dec 2007 Viet Nam confirms its 101st human case in a 4-year-old boy from Son La (onset 21

22 date 7 December 2007). The last case confirmed by Viet Nam had an onset of July Egypt confirms its 40th human case in a 50-year-old woman from Domiatt (onset date 24 December 2007) and its 41st human case in a 22-year-old woman from Menofia (onset date 26 December 2007). 29 Dec 2007 Myanmar reports ongoing outbreaks of H5N1 in backyard poultry in Shan state. 31 Dec 2007 Benin reports H5N1 in poultry in two new provinces (Dangbo and Porto Novo) 3 Jan 2008 Israel reports H5N1 in birds in a petting zoo in Haifa (first outbreak since March 2006) 2 Jan 2008 Egypt confirms its 42nd human case in a 25-year-old woman from Dakahlia (onset date 26 December) and its 43rd human case in a 36-year-old woman from Menofia (onset date 26 December 2007). 4 Jan 2008 China reports H5N1 in poultry in Xinjiang (first outbreak reported in this province since September 2006) 7 Jan 2008 Viet Nam reports H5N1 in poultry in 4 provinces (Tra Vinh, Cao Bang, Thai Nguyen, and Quang Tri). 11 Jan 2008 Indonesia confirms its 117th human case, in a 16-year-old girl from West Java (onset date 30 December 2008) 15 Jan 2008 India reports H5N1 in backyard and commercial poultry in West Bengal State (first since July 2007). Egypt reports widespread H5N1 outbreaks in backyard and commercial poultry (including in vaccinated poultry) in 17 governorates during December and early January. 16 Jan 2008 Iran reports H5N1 in backyard poultry in Mazandaran (first since February 2006). 21 Jan 2008 Ukraine reports H5N1 in poultry in Crimea (first since June 06). 22 Jan 2008 Germany reports ongoing outbreaks of H5N1 in backyard birds in Brandenburg. Turkey reports H5N1 in backyard poultry in Zonguldak (first report since February 2007). 23 Jan 2008 Thailand reports H5 in poultry in Nakhon Sawan and Phichit (first reports since March 2007). Indonesia confirms its 118th human case, in a 32-year-old woman from Banten (onset date 3 January 2008) Indonesia confirms its 119th human case, in an 8-year-old boy from Banten (onset date 7 January 2008). Indonesia confirms its 120th human case, in a 30-year-old man from Banten (onset date 13 January 2008). 24 Jan 2008 Viet Nam confirms its 102nd human case in a 34-year-old man from Tuyen Quang (onset date 10 January 2008). 29 Jan 2008 Indonesia confirms its 121st human case in a 31-year-old woman from Jakarta China reports H5N1 in poultry in the (onset date 18 January 2008), its 122nd Tibet Autonomous Region (first report in human case in a 9-year-old boy from this province since March 2007). West Java (onset date 16 January 2008), 123rd human case in a 32-year-old man 22

23 2 Feb 2008 Pakistan reports outbreaks of H5N1 on commercial farms in Sindh (Karachi)(first reports since November 2007). 5 Feb 2008 China retrospectively reports H5N1 in two wild birds in Tuen Mun Park, Hong Kong SAR (detected in November and December 2007). from Banten (onset date 17 January 2008), and its 124th human case in a 23- year-old woman from Jakarta (onset date 19 January 2008). Indonesia confirms its 125th human case in a 29-year-old woman from Banten (onset date 22 January 2008), and its 126th human case in a 38-year-old woman from Jakarta (onset date 24 January 2008). 6 Feb 2008 United Kingdom continues to report sporadic deaths due to H5N1 in mute swans in southern England (detected in November and December 2007). 11 Feb 2008 According to FAO 28, Indonesia continues to experience outbreaks of H5N1 in poultry. 12 Feb 2008 Indonesia confirms its 127th human case in a 15-year-old girl from Jakarta (onset date 2 February 2008) 13 Feb 2008 Laos reports H5N1 in poultry in Luang Namtha (first report since February, 2007) 15 Feb 2008 Viet Nam confirms its 103rd human case, in a 40-year-old man from Hai Duong (onset date 2 February 2008). 17 Feb 2008 Saudi Arabia reports H5N1 in poultry in Ar Riyad, outbreaks dated from Oct 07 through Jan Feb 2008 Nigeria reports H5N1 in poultry in Anambra (first report since March 2006). 20 Feb 2008 Pakistan reports new H5N1 outbreaks in poultry in North West Frontier province. China confirms its 28th human case, in a 22-year-old man from Hunan (onset date 16 January 2008). 21 Feb 2008 Indonesia confirms its 128th human case in a 16-year-old man from Central Java (onset date 3 February 2008), and its 129th human case in a 3-year-old boy from Jakarta (onset date 3 February 2008). Viet Nam confirms its 104th human case in a 27-year-old man from Ninh Binh (onset date 3 February 2008) 22 Feb 2008 China confirms its 29th human case, in a 41-year-old man from Guanxi Autonomous Region (onset date 12 February 2008). 25 Feb 2008 Viet Nam continues to report outbreaks of H5N1 in poultry from several provinces. China reports H5N1 in poultry in a new province, Guizhou (first report from this province since January 2006). 26 Feb 2008 Turkey reports H5N1 in poultry in a new China confirms its 30th human case, in a province, Sinop. 44-year-old woman from Guangdong (onset date 16 February). Pakistan reports new H5N1 outbreaks in Viet Nam confirms its 105th human case, poultry in Sindh province. in a 23-year-old-woman from Phu Tho 23

24 (onset date 14 February). 28 Feb 2008 Egypt confirms its 44th human case in a 4-year-old girl from Minea (onset date 21 February). 1 Mar 2008 Myanmar reports AI-seropositive ducks detected during surveillance in Shan State (serotype not reported). 4 Mar 2008 Egypt confirms its 45th human case in a 26-year-old woman from Fayoum (onset date 24 February). 5 Mar 2008 Egypt confirms its 46th human case in a 11-year-old boy from Minea (hospitalisation date 26 February). 9 Mar 2008 According to the Ministry of Fisheries and Livestock in Bangladesh, 47 districts have now had confirmed outbreaks of H5 infection in birds. According to the Department of Animal Husbandry, Dairying, and Fisheries in India, additional H5 infection in birds has been confirmed in West Bengal. 10 Mar 2008 Pakistan reports new H5N1 outbreaks in poultry in North West Frontier Province. 11 Mar 2008 Egypt confirms its 47th human case in a 8-year-old boy from Fayoum (hospitalisation date 3 March 2008). 16 Mar 2008 China reports H5N1 in poultry at a live animal market in Guangdong According to FAO, HPAI is still being detected in poultry on three islands of Indonesia, Bali, Java, and Sumatra Mar 2008 Turkey reports H5N1 in backyard poultry in Edirne 25 Mar 2008 Research 30 A study is published describing the epidemiological association between the presence of H5N1 virus and duck populations, human populations, and rice production in Viet Nam and Thailand. 28 Mar 2008 India reports additional outbreaks in backyard poultry in West Bengal 31 Mar 2008 Switzerland reports H5N1 in a healthy wild bird in Luzern Canton (first report in country since June 2006). 1 Apr 2008 Viet Nam continues to report outbreaks of H5N1 in poultry from several provinces. 2 Apr 2008 Republic of Korea reports H5N1 in poultry in Cholla-Bukdo (first report in country since June 2007) Viet Nam confirms its 106th human case, in an 11-year-old boy from Ha Nam (onset date 4 March). Indonesia confirms its 130th human case, in a 15-year-old boy from West Java (onset date 19 March 2008), its 131st human case in a 11-year-old girl from West Java (onset date 19 March 2008) and its 132nd human case in a 21-month old girl from West Sumatra (onset date 17 March 2008). There has been no epidemiological link identified among the cases. 3 Apr 2008 Pakistan confirms two additional cases in a family cluster in North West Frontier Province in Oct-Nov 2007, suggesting 24